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Time and again we hear it from agents considering doing sales meetings or other community events — “But what if a secret shopper comes?” While the concern is completely understandable given the potential ramifications of a CMS complaint, it’s also probably based more in fear than in reality.

They really don’t try to trap you – Secret shoppers may ask you a lot of questions, and they may be specifically asking questions related to areas of concern for CMS, but they won’t go out of their way to ask you the most obscure question possible and trick you into giving the wrong answer. Answer questions compliantly and be honest if you’re not sure of something.

There are example checklists you can look at – Every CMS secret shopper fills out the same survey and is looking for the same things. While CMS doesn’t make the most current one available to the public, you can click here to look at a sample from a prior year. If you know what they’re looking for, you know what you have to do.

Most deficiencies found were for easily avoidable infractions – In 2014, CMS secret shoppers found 305 deficiencies at the events they surveyed. Sixty-nine were for failing to provide and go over star ratings, and 67 were for failing to make available required information like the Summary of Benefits or provider directory when providing an enrollment form. These are easily prevented by making sure you have the necessary materials and that you go over the information required.

If you take a little time and some care, you can put together an informative, compliant event to help grow your business, without fear of a secret shopper lurking around every corner.

As tensions mount over physician reimbursement rates and health systems and insurance carriers seek ways to improve performance to secure higher payments for themselves, more health systems are looking to the unique solution of becoming an insurance carrier in their own right. A number of large regional health systems like Sutter Health and Stanford Health Care have ventured into the individual health and Medicare Advantage markets, and others seem poised to follow suit. So why do health systems want to take on this challenge?

More control means higher star ratings – Star ratings issued by CMS have been an important measure of plan quality and performance for several years, and the expansion of the program to include hospitals and long term care facilities shows that the ratings are here to stay. Star ratings aren’t just a feather in the cap, they afford special privileges like the ability to accept new members outside of the normal enrollment periods and higher reimbursement rates. The success of Kaiser’s Senior Advantage products has proven that having control of the entire process – including providers, pharmacies, and hospitals – is one of the best ways to ensure the kind of efficiency and well-coordinated care that leads to five star ratings. Other large health systems that already have the provider and hospital infrastructure want to leverage their own networks to achieve similar results.

Patients want stable networks – One of the most frequent complaints from consumers is that their carrier’s network changes from year to year, and they have no choice but to change carriers to follow their doctor. Network stability is in fact a frequent topic in discussions of Medicare Advantage reform and regulation. Large health systems who already have affiliated doctors likely see lower turnover rates amongst their providers and can remove some of that stress for their patients, especially in the wake of high profile contract disputes like the protracted negotiations between Sutter Health and Blue Shield.

Patients have relationships with their doctors, not their insurance carrier – As long as claims get paid, very often clients simply want the plan that allows them to see the doctors they’re used to. The providers and health systems that patients use have often had years to build trust, while patients may only interact with their insurance carrier when there’s a problem with a claim being paid or with getting approval for care they need. Some established insurance carriers are beginning to do more client outreach in an effort to change this, but the advantage is still strongly on the side of the doctors and hospitals that people already know and trust.

Increased efficiency means better care and higher profits – The ability to streamline patient care, as well as billing and claims, gets patients the care they need faster and more easily. It can also save money by eliminating unnecessary or redundant procedures and cutting back on the number of steps and man hours it takes to file and process a claim.

While becoming a carrier as well as a health system is a daunting task, it’s a trend on the rise for the simple reason that, if done well, it can lead to better, more efficient care and higher profits.

One of the perks of being an independent insurance agent is being able to make your own schedule and choosing whether or not you work from home. However, working at home comes with its own set of hurdles that you’ll need to overcome. Making sure you’re just as productive at home (or more productive) is important to keeping your business alive and thriving.

Keep a RoutineJust because you’re now working at home doesn’t mean you shouldn’t still get up at a decent hour. “The early bird gets the worm” is still something you should take into consideration, even when working from a home office. Getting up in the morning and going through a typical routine of showering, having breakfast and getting dressed in clothes outside of pajamas will help you get in the right frame of mind to work.

Have a Dedicated Work SpaceHaving a dedicated work space can significantly help you focus on business. Having this space will also help create a mental shift from home life to work life. Making sure your mind is on business is half the battle when working from home.

Have Business HoursCreating a balance between home life and work life is an important thing to establish right from the start when your home becomes your office. With your office at home, it’s easy to work longer hours and think about work in the evenings when you could be spending time with family or friends. Having a set start time and end time will help you keep that balance. It will also help you focus on business instead of letting family obligations cloud your work time.

Don’t Wander AroundKeep out of the kitchen if it’s not time for lunch. Don’t sit in the living room watching TV when you become bored. Make sure people know even though you’re home, you’re not available during work hours. One of the perks of working at home is being in your own space and being comfortable, however allowing yourself to become too comfortable or distracted is going to lower your work production and create bad working habits.

Overall working out of your house could create a more positive quality of life for you, as long as you put in the effort to keep your business up, while also not letting it take over your home.

Medicare Advantage plans saw continued growth over the past year, doing little to change the common notion that managed care will become ever more popular among Medicare beneficiaries. The total number of enrolled beneficiaries increased from 32% of 54 million eligibles this time last year to 33% of 55 million eligibles this year.

Almost all insurers saw growth:
– Total enrollment leader UHC saw a 10.5% increase
– Six of nine other companies with more than 250,000 members saw growth
– Cigna had the largest percentage increase at 13.6%
– Large insurers saw an overall average growth of 5.2%, while small insurers saw an average growth of 5.6%

While UHC and Humana continue to dominate with a combined market share of 38.5%, the fact that smaller insurers saw overall growth similar to the larger insurers is an indicator that the market is sustainable even outside the huge market share of the largest companies. Smaller, more regional carriers are surviving and even thriving.

Selling Medicare Advantage plans does mean extra work with certifications and abiding by CMS regulations, but the increasing market share makes it worth the time and effort. If you haven’t already, get a few MA carriers in your bag and be prepared to offer your clients what a growing number of them may want.

In 2015 there were multiple data hacks with big companies where client’s information was infiltrated, leaving clients vulnerable to fraud. Now, moving forward from these huge data breaches, many companies are cracking down on making sure client’s information is as secure as it can be, especially in the insurance field where client’s information is floating around on applications, ID cards, etc.

As an agent it is your responsibility to keep your client’s data as protected as possible. But what information needs to be protected and how far do you actually need to go to protect the info?

What information needs to be kept secure?

The first thing about making sure your client’s information is protected is knowing what information actually needs to be protected. The most basic and secure answer is that everything should be protected. It is your responsibility to protect any information a client gives you which includes their addresses, email addresses, social security or tax identification numbers, credit card or bank account info, and anything else that you collect that could be used against your client in a fraudulent manner.

This means applications, copies of clients ID cards, and other personal documents all need to be securely stored, whether in electronic format or hardcopy. Also, when disposing of old documents make sure they are disposed of properly such as with a paper shredder or similar method.

How do you keep clients information secure?

Keeping a clients information secure really depends on how you are using your client’s information. Is it a hard copy application or document or is it purely electronic?

Hard Copy: All applications and documents with client information should be kept in a locked area. This could be a room or something as simple as a filing cabinet with a lock. Applications and documents should not be left out in the open or stored in areas easily accessible by outside persons.

Electronic Storage: Documents with client’s information should be kept in limited access areas, even on computers. This means making sure a computer is password protected, and that firewalls and anti-virus software are in place, etc. Also, the computer or server where the client’s info is kept should not be something that is easily accessible by the public or even employees who have no reason to have access.

Electronic Communication: All electronic correspondence regarding your client should be done through a secured manner, such as a secured email system. You can find your own form of secure email by doing something as simple as googling “secure email service” or talk with fellow agents or up line* to see what they’re using.

*Agent Pitstop offers a secure email service for our agents to correspond securely with us, free of charge. If agents would like full access where they are able to email anyone, it is $60 per year.

What can happen if you don’t keep your clients info secure?

If you are not currently doing everything you can to keep your client’s information secure, you are not only putting your clients at risk, but yourself as well. If you are found at fault for not securing your client’s information and it is stolen you could be at risk of not only losing your contracts with carriers but also your insurance license in general.

If you have any questions or concerns about securing your client’s information contact our compliance department at compliance@agentpitstop.com.

Simply put, first dollar coverage is coverage without any deductibles or coinsurance. The coverage is considered “first dollar” because from the first dollar spent, the coverage pays its share. Medicare Supplement Plan F is an example of first dollar coverage, because the plan pays the Part A and Part B deductibles.

How does this change Medicare Supplement plans?

Starting in 2020, plans C and F will only be available to existing Medicare beneficiaries. New Medicare beneficiaries will have their choice of the remaining plans, with Plan G offering the richest benefits. NAIC has also proposed the introduction of a high deductible Plan G to take the place of high deductible Plan F.

Why are they making this change?

Many believe that first dollar coverage encourages overuse of services, because beneficiaries have no financial incentive to limit their care to only what’s truly necessary. By passing along a share of cost even to those people who have Medicare Supplement plans, the hope is to lessen the strain on the Medicare program.

While the new plans won’t take effect for several years, this is sure to significantly change the Medicare Supplement landscape for agents and beneficiaries alike.